As the Oct. 1, 2014, deadline to convert to from ICD-9 to ICD-10 draws closer, healthcare providers who have yet to take significant action are likely growing increasingly anxious. During a webinar hosted by FierceHealthIT last month entitled "What to do NOW to prepare for ICD-10," provider representatives Colleen Deighan and Stephen Stewart discussed steps each of their organizations have taken to prepare for the shift.
"The interesting thing is, the dynamics and the scope of what we're dealing with here is the same whether you're small or very, very large," Stewart, CIO at Henry County Health Center, a 74-bed hospital in Mount Pleasant, Iowa, said. "I can recall very vividly sitting in a [College of Healthcare Information Management Executives] conference in 2010 and hearing the first presentation on ICD-10 and a cold fear fell over me as i thought about the fact that 'there's a lot to do here and we haven't done anything yet.'
What follows are answers by Stewart, who also serves as a member of FierceHealthIT's Editorial Advisory Board, and Deighan--the senior program director for ICD-10 implementation at Cleveland Clinic--to follow-up questions from attendees that cover everything from dual coding to ensuring vendor readiness.
Question: How long past Oct 1, 2014, will you maintain dual coding? Are you doing any code translation?
Stewart (right): I believe that will depend on the state of readiness of our payers. I firmly believe some will not be ready and we may have to extend past Oct 1. We are planning on maintaining dual coding at least through the 2014 calendar year.
Deighan: We will not be performing dual coding past the compliance date. We expect that if payers are not ready, they may map our claim back to ICD-9, but have no plans ourselves to perform dual coding after the compliance date.
Question: Can you (Colleen) specify the percentage of impact that you predict for practices after ICD-10 implementation?
Deighan: If the question is around productivity, we expect HIM coders to have a 20 to 50 percent drop in productivity, one of the other reasons dual coding is important. If computer assisted coding is used, it is expected to be more like 20 percent; if no CAC exists, then 50 percent. For providers, there likely will be a 10 to 15 percent drop as they learn the new documentation requirements for ICD-10. Both coding and providers will have some permanent decrease in productivity due to the granularity of ICD-10, but I'm not sure yet what that will be.
Question: Which type of providers do you suspect to be impacted by ICD-10 the most?
Stewart: Primary care/family practice/internal medicine providers, as they deal with the broadest range of conditions.
Deighan (left): I agree with primary care and emergency medicine overall, due to the range of conditions they treat. Other specialties with big changes that will be heavily impacted include orthopedics, vascular surgery, cardiology and OB.
Question: Will the administration cave to pressure to move the date (or make the date a soft date) on the anniversary of the HealthCare.gov debacle to avoid more egg on their face?
Stewart: I would predict more of a chance to delay Meaningful Use Stage 2 than I would delay ICD-10. Politics makes strange things happen, but moving this one in an election year does not look probable to me.
Deighan: Meaningful Use Stages 2 and 3 were extended and delayed, respectively, recently by CMS; to that end, I believe that there will be no delay on ICD-10. However, there is new traffic around testing (end-to-end) that CMS said they will not do that may change that.
Question: What kinds of questions should ambulatory practices ask to their EHR vendors regarding ICD-10 readiness?
Stewart: The EHR vendors all have to have 2014 Certified code for Meaningful Use Stage 2, and that must include ICD-10. So I would focus on their 2014 Code, ICD-10 readiness, but very specifically ask them how they are executing the change. Get coders and health information management professionals involved in evaluating the new workflows as they will be impacted. Not that you can change things, but knowing what you are about to get into is a big plus.
Deighan: Mapping is a big question to understand from your EHR vendor; there is a ton or remediation that needs to be done at the facility level to ensure that your EHR is ready. Your vendor should have a work plan for you to follow.
View the "What to do NOW to prepare for ICD-10" webinar on demand
Question: Do you have any experience with how [health information exchanges] are preparing and how much they will be affected by ICD-10?
Stewart: I worry that since they do not enter the codes, that it is perceived as not a high priority for non-clinical practice healthcare organizations. There is only one current HIE in Iowa, and we were the first hospital on it. I do not think they are as concerned about this as we are, as they are only worried about moving continuity of care documents at this time. When, or if, they move to discrete structured data, that will change.
Question: Can you elaborate on the length of the testing period and what measure is used for efficacy of that period?
Stewart: I believe the length of time will be driven by how long it takes to get test files approved by the vast majority of your payer mix. Efficacy, in my mind, should be driven by reimbursement. I'm not sure we are going to know that in testing.
I plan to measure, first, what can we code at all and what can we not code due to insufficient documentation. Then, I'll calculate the gross charges on the un-codable, and launch a crusade to drive the point home as to the financial impact.
The first step is getting files accepted by your payers. That is huge. The second is measuring what those files mean to your business. Since I do not believe we are going to know what gets reimbursed for a period of time, nor how that will change with the mining of data going forward, our goals are to get clean claims out the door, measure the reimbursement impacts we know, and use those measurements to project what we believe is coming at us.
These answers have been edited for content and clarity.